24 h blood pressure profile affects the left ventricle independently of the pressure level. A study in untreated essential hypertension diagnosed by office blood pressure readings

This work examines whether the 24 h blood pressure (BP) pattern per se might affect the left ventricular structure independently of the pressure level. One hundred subjects with abnormally high office BP readings who had never received any antihypertensive treatment were submitted to 24 h ambulatory BP monitoring and left ventricular echocardiographic assessment. They were classified into two groups, as follows: dippers (group 1), consisting of 46 subjects whose mean nighttime systolic BP was reduced by at least 10% in comparison to the corresponding daytime value, and nondippers (group 2), consisting of 54 subjects whose nighttime BP did not drop or was reduced by < 10%. Left ventricular mass and end-diastolic volume values, both normalized for body surface area, were significantly higher in nondippers (r = 3.12, P <.003, and r = 7.46, P < .001, respectively). The two groups did not differ in diastolic thickness of either intraventricular septum or left ventricular posterior wall (both values normalized for body surface area), in mean 24 h systolic or diastolic or average blood pressure, or in age. In conclusion, in untreated essential hypertension diagnosed on the basis of abnormal office BP readings, the higher incidence of left ventricular mass increase in subjects unable to reduce their blood pressure during the night was more due to left ventricular dilatation than to myocardial wall thickening. The effect of the 24 h BP profile on left ventricular volume appears to be independent of both the BP level and age

Left atrial and left atrial appendage functional abnormalities in patients with cardioembolic stroke in sinus rhythm and idiopathic atrial fibrillation

Thrombogenesis in the left atrial appendage (LAA) has been related to the special morphology of this cavity and to its size and degree of dysfunction. However, no study has focused on LAA function in conjunction with left atrial (LA) function in both sinus rhythm (SR) and nonrheumatic idiopathic atrial fibrillation (AE) in relation to clinical status (cardioembolic stroke). Forty-three patients in SR (14 patients with stroke, 29 control subjects) and 45 patients in AF (27 patients with stroke, 18 control subjects) were examined by transthoracic and transesophageal echocardiography. Baseline clinical characteristics and standard transthoracic and transesophageal measurements of the LA and LAA (size, fractional area change, flow measurements, spontaneous echo contrast, and thrombus) were recorded and compared in relation to cardiac rhythm. Patients in the stroke-SR group showed a significant decrease of fractional area change in the LA (32% +/- 15%) and LAA (34% +/- 15%) in relation to control subjects (43% +/- 10%, p = 0.035, 49% +/- 13%, p = 0.006, respectively). Patients in the stroke-AF group showed significant reduction of appendage flow measurements (outward velocity = 22 +/- 13 vs 33 +/- 19 cm/sec, p = 0.036), whereas no differences were detected in the center of the LA. In multiple regression analysis, the presence of cardioembolic stroke was positively associated with the presence of spontaneous echo contrast (p = 0.0253) and spontaneous echo contrast negatively associated with appendage inward flow velocity (p < 0.001). Cardioembolic stroke in patients in SR is associated with a global decrease of shortening in both cavities and in patients with AE, with a reduction of LAA flow parameters. Patients with spontaneous echo contrast, thrombus, or both showed further reduction of shortening and flow velocities in both cavities, indicating a more advanced stage of dysfunction

Impact of gender on 24-h ambulatory blood pressure and target organ damage

Differences between male and female subjects in mean 24 h blood pressure (BP) values and target organ damage such as left ventricular mass (LVMASS) and intima-media thickness (IMT) of carotid arteries were explained. The study population consisted of 1445 subjects. All subjects underwent 24 h ambulatory BP monitoring, left ventricular echocardiography and measurement of IMT of carotid arteries. Men and women did not differ in age, body mass index (BMI) and clinic BP values. Mean 24 h systolic and diastolic BP were significantly higher in men compared to women. LVMASS corrected for body surface area or height2.7, IMT of common (MCCA) and internal (MICA) carotid arteries were found to be significantly higher in men compared to women. Analysis of covariance showed that men had significantly higher LVMASS, MCCA and MICA than women, after adjustment for BMI, age, smoking status, mean 24 h systolic and diastolic BPs, fasting serum glucose, total cholesterol and triglycerides. These findings indicate that male sex could be an important predictor of higher mean 24 h BP and target organ damage for subjects of similar BMI and clinic BP values

Ambulatory blood pressure monitoring and target organ damage: Effects of age and sex

OBJECTIVE: The objective of the present study was to investigate the effect of age and sex in the ambulatory blood pressure measurements, and target organ damage. METHODS: A total of 1596 patients (50.6% male and 49.4% female), aged 10-87 years, referred to our Hypertension Center for borderline hypertension, underwent 24-h ambulatory blood pressure monitoring, left ventricular echocardiography and measurement of intima-media thickness of carotid arteries. RESULTS: Adolescent girls had higher mean 24-h and clinic systolic and diastolic blood pressure values than adolescent boys. Men aged 20-60 years had higher mean 24-h and clinic systolic and diastolic blood pressure values than women of the same age. Men older than 60 years had higher mean 24-h systolic and diastolic blood pressure values than women of the same age, but women older than 60 years had higher clinic systolic and diastolic blood pressure values. White-coat effect increased with age in both sexes, but the magnitude of the white-coat effect was higher in women than in men at older ages. Men had higher left ventricular mass corrected for body surface area or height than women in all ages and significantly higher differences in ages between 30 and 80 years. In addition, men had greater carotid intima-media thickness than women in all ages and significantly higher differences in ages between 30 and 80 years. CONCLUSIONS: Men have greater ambulatory blood pressure values and target organ damage than women of the same age. © 2006 Lippincott Williams & Wilkins

Impact of obesity on 24-hour ambulatory blood pressure and hypertension

The purpose of the present study was to determine the relationship between body mass index (BMI) and parameters derived from 24-hour ambulatory blood pressure monitoring including mean 24-hour daytime and nighttime systolic and diastolic blood pressures, 24-hour daytime and nighttime pulse pressure, mean 24-hour daytime and nighttime heart rate, dipping and nondipping status. 3216 outpatient subjects who visited our hypertension center and were never treated with antihypertensive medication underwent 24-hour blood pressure monitoring. BMI was significantly correlated with clinic systolic and diastolic blood pressures. Significant correlations were also found between BMI and mean 24-hour daytime and nighttime systolic blood pressure, 24-hour daytime and nighttime pulse pressure, and mean 24-hour daytime and nighttime heart rate. In multivariate regression analysis, clinic systolic, diastolic blood pressure, mean 24-hour systolic blood pressure, 24-hour pulse pressure, and high-density lipoprotein were independently correlated with BMI. The incidence of white coat hypertension was higher in overweight and obese patients than in normal weight subjects. Confirmed ambulatory blood pressure hypertension was also found to be higher in overweight and obese individuals compared with normal weight subjects. Our data also highlight the higher incidence of nondipping status in obesity. These findings suggest that obese patients had increased ambulatory blood pressure parameters and altered circadian blood pressure rhythm with increased prevalence of nondipping status

A self‐learning approach to history‐taking

Summary. The present study examines the effectiveness of self‐learning in interviewing skills training. Self‐learning was carried out by self‐evaluation of one's interviews by the use of an audiotape. Fifteen doctors specializing in internal medicine listened to their interviews and evaluated themselves against the suggested performance included in a rating scale. This procedure was repeated twice and composed the educational programme. Three main aspects of history‐taking were involved: (1) eliciting patient information; (2) interviewing technique and (3) attitudes toward the patient. Comparison of performance at the first and third interview revealed significant improvement in all three aspects. Doctor‐patient communication and written history performance were involved indirectly in the study but no significant improvement was revealed. The educational approach appeared simple and effective to the doctors. It is suggested that a brief programme of self‐learning with feedback from audiotapes is both convenient and effective, improving essential aspects of history‐taking performance. 1990 Blackwell Publishin

Effect of pacing mode and pacing site on torsional and strain parameters and on coronary flow

Background: Right ventricular apical pacing may induce detrimental effects on left ventricular function and coronary flow. In this study, the effects of pacing site and mode on cardiac mechanics and coronary blood flow were evaluated. Methods: This prospective study included 25 patients who received dual-chamber pacemakers with the ventricular lead placed in the right ventricular apex and presented in sinus rhythm (SR) at their regularly scheduled visits at the pacemaker clinic. Patients underwent complete transthoracic echocardiographic examinations while in SR, followed by noninvasive Doppler assessment of coronary flow in the left anterior descending coronary artery (LAD) and speckle-tracking echocardiography of short-axis planes in SR, atrial pacing (AAI-P), atrioventricular (dual-chamber) pacing (DDD-P), and ventricular pacing (VVI-P). Results: Rotation of the base was significantly decreased with VVI-P compared with AAI-P. Left ventricular twist decreased significantly with DDD-P compared with AAI-P. Circumferential strain of the base significantly decreased with DDD-P and VVI-P compared with SR. The velocity-time integral of diastolic flow in the LAD decreased significantly with DDD-P compared with SR (10.7 ± 2.2 vs 10.2 ± 2.2 vs 8.9 ± 1.6 vs 8.7 ± 2.6 cm in SR and with AAI-P, DDD-P, and VVI-P, respectively, P = .003). Basal rotation and time from onset of the QRS complex to peak basal rotation as a percentage of systole were independently associated with the velocity-time integral of diastolic flow in the LAD during SR and the three pacing modes. Conclusions: Acute right ventricular apical pacing showed a detrimental effect on left ventricular twist and basal mechanics, with the latter being independently associated with decreased LAD diastolic flow velocity parameters. Copyright 2015 by the American Society of Echocardiography